Why are we still debating about breastfeeding?

Note: This post was drafted several weeks ago, shortly after the publication of the article it discusses. My initial intention was to publish it right away, but to be honest I was uneasy because I felt like I didn’t dislike the article as much as I “should”. While that ended up being a fantastic inner monologue leading me to some interesting insights about the nature of science and of communication, it did not do me any favors in terms of cashing in on the debate.  In short, you might say that I wussed out. But in any case, here’s the basic story as I see it.

 Back in February an article in the journal Social Science and Medicine made some minor waves with its claims that breastfeeding- currently exalted within Western culture as The Way Things Ought To Be- is completely overrated. At least, that’s what some in the media would have us believe. The study, headed by two sociologists at Ohio State University, looked at longitudinal data from three groups: 8,237 children, 7,319 sibling pairs, and 1,773 sibling pairs within which one sibling was breastfed and the other bottle-fed. The investigators analyzed data on a number of markers for physical and mental health, including body mass index (BMI), obesity, asthma, hyperactivity, parental attachment and behavior compliance as well as vocabulary, reading recognition, math ability, intelligence and scholastic competence. Though breastfed children did seem to have an advantage in terms of most of these metrics, there was no statistically significant difference between the breast- and bottle-fed siblings in the discordant pairs- a finding which indicates that the similarities of experience for these sibling pairs outweighs the effects of their different feeding styles.

            That sounds like a reasonable enough conclusion, but I have plenty of questions about their results. They looked at an impressive list of metrics, sure, but they certainly didn’t look at everything (plus I have my doubts as to whether something “parental attachment” can truly be summed up quantitatively anyway). And there are fundamental issues with the independent variable, like the fact that breastfeeding time is measured in weeks- quite short compared to current guideline- and  that exclusive vs. mixed feeding was not accounted for in analysis, that muddy the whole picture and make it harder to base any definitive claims on the data.  But all in all, this is not a terrible article. It’s just that it says a few very specific things about very specific infant feeding dynamics in a relatively privileged western society…and that’s all.  Information on the short-term benefits of breastfeeding (Horta and Victoria 2013)- including passive immunity- are acknowledged but glossed over as though they are have no connection to long-term outcomes, and the potentially protective effect for breastfeeding mothers against breast cancer is missing altogether (MÖller et al 2002).  Additionally, while the study controlled for socioeconomic status, there are just *so many* other confounding variables that could not be addressed with the existing data set (post weaning diet, physical activity levels, exposure to allergens, prenatal environment…) that extracting meaning from this is like looking at a puzzle with half the pieces missing.

E.A. Quinn, an Anthropologist and breastfeeding researcher who blogs at Biomarkers and Milk,  makes the point that nothing in the article is especially newsworthy for anyone with a solid background in breastfeeding science. Given that I am NOT a breastfeeding researcher, though, it was news to me.  And it will certainly be news to most readers.  Most importantly, it was considered “news” to the study’s authors, who not likely to be extensively trained in human biology (though to be fair, Dr. Colen does have substantial background in public health) and so were perhaps not fully equipped with the understanding of physiology necessary to adequately and responsibly contextualize their findings. All in all, this leads to substantial potential for public misinterpretation.          

 There’s a piece at Evolutionary Parenting  that eloquently tackles both the study’s limitations and the way the information has been misrepresented in the media better than I ever could. The post points out that, while the authors should bear some responsibility for this runaway train (they did, after all, begin the title of their article with the question “Is breast truly best?”, and I can’t imagine they didn’t know where that might lead) it really is the journalistic community who ought to be called out for the unnecessarily clickbait-y headlines.

The very first two hits on the word “breastfeeding” this morning are "There's Way More to Parenting than Breastfeeding", at the Boston Globe (perfectly fine!), "Breastfeeding Benefits Overstated?" (Less fine, as far as I’m concerned)

With just a little bit more effort (search terms “breastfeeding 2014") you can find this gem over at Slate, which is the article that popped up on my Facebook newsfeed the other day and irked me enough that I had to write this post.

What it comes down to is this: The decision whether or not to breastfeed is a really big deal to most new mothers. It is true that our current cultural climate is such that many women feel guilty and shamed if they are unable or reluctant to breastfeed.  That is 100% wrong, and I wish it were not the case.  I also believe, though, that everyone who wants to explore breastfeeding should be able to do so in a supportive environment with accurate *and complete* information readily accessible to them.  Inflammatory headlines claiming no real benefits to breastfeeding are shallow and misleading.  OF COURSE no one should have to feel bad about opting to formula feed, but no one should be made to feel like they're buying a myth for opting to breastfeed, either, because it's simply not true. There are aspects of infant attachment and well-being that cannot be easily quantified, and even if we accept that they won’t change the entire trajectory of a child’s life, they still matter.

If you read through the blog posts and articles mentioned, including the press release for the study itself, you’ll notice a common thread of looking out for mothers and wanting to help create that more supportive environment regardless of feeding method.  It seems that in the end everyone’s gotten this one vital aspect right, at least.  But this is proof that we can do better- breast vs. bottle does not need to be a divisive issue with victories or losses to tally up.  I only wish everyone would acknowledge that up front instead of giving in to the impulse to antagonize. For an informative and thought-provoking take on breastfeeding, check out The Situated Mother by the ever-insightful Kaitlin Drouin. And, as always, let me know what you think about all this.

Sources:

Colen CG, Ramey DM. Is breast truly best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons. Social Science & Medicine. 2014. doi:10.1016/j.socscimed.2014.01.027.

Drouin, K. H. (2013). The situated mother: Evolutionary theory and feminism as complementary components to understanding breastfeeding behavior. Journal of Social, Evolutionary, and Cultural Psychology, 7(4), 326.

Horta BL, Victora CG: Long-term effects of breastfeeding: a systematic review. Geneva, Switzerland: World Health Organization; 2013

Möller, T., Olsson, H., Ranstam, J., & Collaborative Group on Hormonal Factors in Breast Cancer. (2002). Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease. Lancet, 360(9328), 187-195. Retrieved from https://lup.lub.lu.se/search/publication/1123899 on March 16 2014

My experience with the science writing tutorial (Dr. Little used that word the other day and I really liked it.  Less cumbersome than independent study) has been interesting so far.  It has become obvious at this point that my plan to use this to make myself a more prolific writer has not worked, but honestly I've realized that I'm all right with that.  I find myself so much more interested in *consuming* science news than in writing  it myself.  There are just so many people already reporting the facts of a story that it's hard to get excited about doing the same. What I've been doing is choosing current events that catch m eye and then reading the story from every news source I can find. A few weeks ago I looked at that story about how Alzheimer's may be the 3rd leading cause of death.  This week I'm focusing on the Ebola outbreak in West Africa.  My goals are to figure out some general trends in science reporting for lay audiences and also to identify agencies that do (in my opinion) an especially great job on a consistent basis. It's a serious mission- I've got spreadsheets and everything. I don't know what shape this is going to take over the remainder of the semester, but I'm hoping at the very least that I will leave knowing who to trust (and who to advise others to trust).  These days there's an absolute overload of information available on just about every topic, and it's impossible for even a dedicated consumer to keep up with completely. I guess this is my way of setting up for the knowledge building equivalent of "work smarter, not harder"...which ironically requires that I spend a bunch of time on trial and error, figuring out what "smarter" is.

Anyhow, I just wanted to check in and update you guys. I do have a couple of substantive pieces in the works that I'll hopefully be putting up soon, and I'm contemplating a few others.   In the meantime, let me know what you think of my newest venture. And if you get a chance, maybe check out this particularly impressive specimen of science reporting ;)

Well, it's been a sort of off-kilter few weeks- tons of snow and messed up travel plans, birthday goings-on and deadlines passing by unnoticed.  Plus I've been trying to kick a head cold for the past few days, which means I haven't had a good night's sleep in a while (Quick aside: those little plastic things you put on your nose to help you breathe at night are awful.  They don't do a whole lot and when you have to pull them off it feels like you're removing half the skin from your nose at the same time.)  I've got a few posts in the works (thoughts on getting older, thoughts on anxiety...coincidence?)  but nothing quite post-worthy yet.  And I'm still taking requests for content while I am defining this space, so if you've got a burning "Why do our bodies do that?" "What's the deal with __________" question, leave it in the comments and I will find out for you.

(For now, I must leave you all so I can make some tea and google "how do I make snot stop pouring out of my face?".)

For Kim, A post about water

The other day I posted on facebook asking for blog ideas from my friends, and the lovely Kim W.- book sale junkie, top-notch conversation partner and (spoiler alert) clean water crusader- suggested I talk a little bit about why safe water is such a huge deal. And as it happens, I have recently been tasked with researching water-borne infectious disease for a group project anyway...which means this is pretty much the perfect opportunity to share what I've learned, because it is an important public health issue. It's a little hard to stomach some of the details, but that's kind of the point- it is easy to take things like clean water for granted when you've never gone without.  It's easy, even as a public health advocate, to get lost in the statistics and not think about what those numbers really mean.

So according to the CDC, nearly 4% of the disease burden around the world is a result of poor water quality.  Nearly two billion people (1.8 billion according to the non-profit Water for People...about a quarter of the world's population)  do not have access to safe drinking water, which means that they are at risk of a host of bacterial, viral, parasitic and fungal infections, not to mention illness caused by environmental toxins. A great many of these individuals are children, whose bodies are ill-equipped to withstand the stress of disease.

The biggest problem in affected areas is that, due to poor sanitation and water treatment, waste from humans and animals is leaching into the water supply, and the majority of these pathogens are transmitted via the fecal-oral route.

So, put more bluntly- lots and lots of people get horribly sick because their water has poop in it. I know we all know that, in theory, but still. I will think about it the next time I complain that the stuff coming out of my tap tastes a little too mineral-y for my liking or when the hot water in the shower runs out before I have a chance to finish rinsing my conditioner.

But anyway, back to the scary numbers. Diarrheal diseases like cholera and giardia and various dysenteries are responsible an estimated 1.5-2 million deaths per year, or roughly 4% of all deaths. This problem is compounded because individuals who are already malnourished or undernourished- another HUGE issue, of course, in many parts of the developing world, are at increased risk of becoming severely ill or dying from dehydration. Same for young kids or the immunocompromised.  Plus it's kind of hard sometimes to rehydrate properly when your water is what made you sick in the first place.

Diarrheal and dysenteric diseases are major players- and usually the most deadly on a population level, but they are not the only threats out there.  Both hepatitis A and E can be transmitted through water,and although they are generally mild in young people they can be deadly for older individuals or those whose immune systems or livers are not functioning adequately. For pregnant women, the risk of acute liver failure from hepatitis E is quite significant.  Additionally, a number of parasitic infections are spread through water.  Schistosomiasis, a helminth infection that likely affects nearly 250 million people (with another 400 million of so at risk), doesn't even require ingestion of water for transmission.  The larvae of these flatworms crawl right through a person's skin while they are swimming, bathing, washing clothes...they are at risk, essentially, any time they have any part of their body in contaminated fresh water. Infections are often asymptomatic, or nearly so, for several months but over time inflammation and scar tissue can lead to damage of the lungs, liver, intestines, bladder, spleen and, more rarely, other organs. Eggs laid by the adult worms within an afflicted individuals gut or bladder are shed into the water, where the cycle begins anew.

I could go on, but I think you guys get the point. Contaminated water is a MASSIVE problem for a pretty significant portion of the population of our planet.  Every once in a while I take a good look at something like this and it sorta knocks the wind out of me for a second. But I'm glad, because it might just make me a more responsible citizen in the long run.

So what do you guys think?  Did you find these numbers surprising at all, or not so much?  If you're feeling inclined to put something toward solving this problem, here are a few good charities:

 Water for People
Schistosomiasis Control Initiative

Writing on purpose is hard!

Also hard?  Writing about parenting when you are not a parent.

I've spent the past three days typing and deleting about a half dozen attempts to put together a meaningful article on attachment parenting co-sleeping and all I have to show for it is a semi-decent intro and a link to James McKenna's website, where readers can go to learn about all the stuff I can't seem to manage to sum up on my own.

The thing is, I am invested in this topic. Every time I hear someone go off on their unsubstantiated tangents about how sleeping near your kids is ridiculous and backward and just the stupidest thing ever, it makes me want to tear my hair out. I really want to write something that might make someone stop and re-think their knee jerk opposition to co-sleeping because the appeal, for me is not only based in the science (of which there is a good amount), but also in the idea that it just makes sense to me on a very fundamental level. And so although there is a bias that I want to avoid having show through in the article, it's in the background coloring my thoughts on the subject, making me excitable and chipping away at my focus. I want to keep piling on the evidence- from physiological studies, yes, but also from ethnographic accounts and psychological literature. Each of these perspectives alone can fill a book. And everything I present can be- and probably is, somewhere in the vastness of the web- refuted with equal conviction.  So there's that to address, too, if I am going to do this right.

The scope of this subject is bigger than I realized, and my desire to responsibly and thoroughly discuss everything about it  is paralyzingly ambitious even without bringing in the fact that my not having children will potentially cost me a lot of credibility with some readers right off the bat.

Of course, this isn't all about co-sleeping at all.  I will likely find myself up against the same challenges when I try to write about vaccines, or mental health or obesity or pretty much any of the topics I would feel compelled to weigh in on in a public forum.  This is about me learning how to effectively deal with false starts and crummy first drafts and meandering paths to a final piece.  It's about me being letting something be not-so-good before it gets good and accepting- really accepting- and taking advantage of the fact that my perspective is limited and a responsible piece of writing in the social science simply should not be crafted just in the microcosm of the author's head.

So there it is.  I'm not sure how much to say, how to say it, or who I should rightfully say it to.  Clearly I am off to a great start.

Ethnography of a millenial anthropology blogger

I've decided for the sake of authenticity (and bookmarks) to keep this url for all posts related to the science writing course and beyond. This means, of course, that Dr. Little will maintain his current access to the occasional stuff-you-don't-necessarily-discuss-with-your-professor, but it also means that I can freely explore the experience of bringing biomedical anthropology to a larger audience without obsessing over where my different voices begin and end.

Which is important, because as I've said before- anthropology is about context.  Holism and relativism are hallmarks of the field; we operate intentionally and unapologetically in the gray areas and I'm going to put my money where my mouth is.  I expect it to be something of a challenge, as I've seen a number of bloggers struggle to find a balanced style that is both natural and professional.  And the topics that are at the heart of biomedical anthropology often necessitate discussion of sensitive topics such as race, class, identity, parenting practices and countless others. I am sure there will be missteps along the way, and I am just as sure that this will be a worthy learning experience that will ultimately make me a better scholar, a better contributor to the larger community and possibly even a better person.

Here's to the adventure.

So I am just over a month shy of my 30th birthday and two weeks away from the start of my final semester at Binghamton.  I don't know how this happened or where the past two years have gone, but this is a pretty fantastic feeling.  I've been compiling a list of companies that look like they might consider hiring a biomedical anthropologists...no leads yet, but it's early.

I probably don't need to mention that this blog didn't exactly fulfill its highest potential thus far. In my grandest get-yer-ass-in-gear effort to date, however, I have signed myself up for a credit bearing independent study (Science Writing in Biological Anthropology) that will require a substantial commitment to maintaining an active online voice.  Of course, given that I've created the syllabus for this little gem, the effectiveness of the plan has some limitations.

ANYwho, I'm heading off to Seattle tomorrow to visit Brennan and meet his fiancee, then will be spending the rest of the break earning some pocket money at the construction company and tying up working on starting some projects that I'd really like to have completed before I go back. I don't know if my "official" professional blog will be here or not (I feel like there's maybe a lot of whining over here, and that maybe a lot of whining is not how one wants to debut her professional presence...yes? No? Let me know.)  Either way, I'll surely be in touch.